Study: Strong State Laws Can Help Curb Binge Drinking
Strong state laws can help curb binge drinking, according to a new study in the American Journal of Preventive Medicine. Binge drinking, defined as more than four or five alcoholic drinks in a two-hour period, is a factor in about half of the 80,000 alcohol-related deaths each year. Researchers analyzed and graded 29 alcohol control policies across the United States, finding that those with the better policies were one-fourth as likely as those with poorest scores to have binge drinking rates in the top 25 percent of states. They also found that rates were 33 percent higher in states in the bottom quarter of grades than those in the top quarter. "Unfortunately, most states have not taken advantage of these policies to help drinkers consume responsibly, and to protect innocent citizens from the devastating secondhand effects and economic costs from excessive drinking," said study senior author Tim Naimi, MD, an associate professor of medicine at Boston University Schools of Medicine and attending physician at Boston Medical Center. "The bottom line is that this study adds an important dimension to a large body of research demonstrating that alcohol policies matter—and matter a great deal—for reducing and preventing the fundamental building block of alcohol-related problems." Laws and policies that can help prevent binge drinking include limiting hours of sale, increasing alcohol taxes and holding those who sell alcohol legally responsible for harm inflicted by consumers who recently consumed alcohol, according to the U.S. Centers for Disease Control and Prevention. Read more on alcohol.
VP to Announce $100M to Improve Access to Mental Health Services
Vice President Joe Biden will today announce $100 million to improve access to mental health services across the country. The plan comes a year after the school shooting in Newtown, Connecticut, and Biden will make the announcement at a meeting of the families of the victims of the tragedy and mental health advocates. The U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA) will provide the funding. "HHS will soon issue a $50 million funding opportunity to help Community Health Centers establish or expand behavioral health services for people living with mental illness or addiction," said a White House official, according to Reuters. "Additionally, USDA has set a goal of financing $50 million for the construction, expansion, or improvement of mental health facilities in rural areas over the next three years." Read more on mental health.
Kids Who Watch Violent Movies Also Exposed to Other Risky Behaviors
Exposing kids to violent movies can also expose them to other examples of potentially harmful behavior, according to a new study in the journal Pediatrics. "Parents should be aware that youth who watch PG-13 movies will be exposed to characters whose violence is linked to other more common behaviors, such as alcohol and sex, and that they should consider whether they want their children exposed to that influence," said study lead author Amy Bleakley, a policy research scientist at the University of Pennsylvania's Annenberg Public Policy Center. The study analyzed nearly 400 top-grossing movies released from 1985 to 2010, finding that 90 percent included at least one act of violence that involved a main character, and that a main character used tobacco, consumed alcohol or engaged in sexual behavior in 77 percent of the films. Read more on violence.
NewPublicHealth Q&A: John Auerbach and Cheryl Bartlett on the Massachusetts Prevention and Wellness Trust
The Massachusetts Prevention and Wellness Trust is a four-year, $60 million project designed to support prevention and health-promotion activities in the state. The first project of its kind in the United States will fund six to 12 collaborative initiatives, and partners on the initiative will include municipalities, community-based organizations, health care providers, regional agencies and health plans. Information on the Trust is detailed in a new report prepared by the Institute on Urban Health Research and Practice at Northeastern University and funded by the Robert Wood Johnson Foundation.
The vision behind the creation of the project is to give all Massachusetts residents the opportunity to live in communities that promote health, as well as seamless access to all community and clinical services needed to prevent and control chronic diseases. It was created because while there is access to health insurance and health care in Massachusetts, health costs continue to rise. The goals of the project include:
- Reducing the rate of the state’s most costly preventable health conditions
- Reducing health disparities
- Increasing healthy behaviors
- Increasing the adoption of workplace wellness programs
- Developing a strong evidence base of effective prevention programs
In order to implement these goals, the Massachusetts Department of Public Health identified four priority areas: tobacco use, childhood asthma, hypertension and elder falls prevention—all of which should be considered closely when working to reduce health disparities and co-occurring mental health conditions in these areas.
A new infographic created for the Prevention and Wellness Trust’s inauguration perfectly illustrates how community links work together to improve health under the principles of the Trust. For example, a diagnosis of hypertension would need a provider to prescribe medications, but the obesity and exercise needs that would also improve the condition for many patients requires input from other community entities, including:
- Classes in exercise, medication and stress reduction by community agencies
- Chronic disease self management classes and home visits for medication use instruction by a community agency
- A neighborhood policy that provides support for transportation changes to encourage walking or biking and zoning for healthy food stores
- A neighborhood policy that provides support for more accessible recreation options in parks and city centers for increased stress reduction
- Workplace policies that provide support for workplace wellness programs that help provide and encourage exercise, healthy foods and stress reduction
NewPublicHealth recently spoke with John Auerbach, a Professor at Northeastern University and the primary author of a report on the Trust, and Cheryl Bartlett, public health commissioner of Massachusetts and the lead person charged with its implementation.
Improved Prevention and Treatment Decrease U.S. Stroke Deaths
Stroke deaths in the United States have declined dramatically in the last few decades because of improved prevention and treatment, according to a scientific statement published in Stroke, published by the American Heart Association. “The decline in stroke deaths is one of the greatest public health achievements of the 20th and 21st centuries,” said Daniel T. Lackland, DrPH, chair of the statement writing committee and professor of epidemiology at the Medical University of South Carolina, in Charleston, S.C. “The decline is real, not a statistical fluke or the result of more people dying of lung disease, the third leading cause of death,” said Lackland, who added that “although all groups showed improvement, there are still great racial and geographic disparities with stroke risks as well many people having strokes at young ages [and] we need to keep doing what works and to better target these programs to groups at higher risk.” Public health efforts that have helped lower stroke rates include hypertension control that started in the 1970s; smoking cessation programs; improved control of diabetes and high cholesterol levels; and improved stroke treatment options. Read more on prevention.
NHTSA Announces New Safety Efforts for Older Drivers
The National Highway Traffic Safety Administration (NHTSA) has announced a new strategic plan to help ensure the safety of older drivers and passengers. In 2012, according to NHTSA, more than 5,560 people over the age of 65 died, and 214,000 were injured in motor vehicle crashes. That’s a three percent increase in the number of fatalities and a 16 percent increase in the number of injuries from the previous year. In addition, since 2003 the population of older adults—defined as age 65 and older—has increased by 20 percent and the number of licensed older drivers increased by 21 percent, to 35 million licensed older drivers in 2012.
NHTSA has several new efforts in place to reduce these deaths and injuries:
- The agency is researching advanced vehicle technologies, including vehicle-to-vehicle communications, collision avoidance and crashworthiness that could help reduce the risk of death or injury to older occupants in the event of a crash. It is also considering adding a “silver” rating system, meaning cars with certain technologies might be preferable for older drivers.
- NHTSA will conduct studies to better understand the effects of age-related medical conditions, including dementia.
- NHTSA will continue public education efforts on functional changes that can impact driving, including vision, strength, flexibility and cognition.
Read more on transportation.
Poll: Parents Concerned Over Lack of Physical Activity During School Day
A recent poll conducted by the Harvard School of Public Health, National Public Radio and the Robert Wood Johnson Foundation found that many parents are concerned about inadequate levels of physical education at schools. More than 1,300 parents of public school students were polled on a range of issues concerning education and health in the their child’s school, and one in four parents (25 percent) said their child’s school gives too little emphasis to physical education, compared with one in seven who say the same thing about reading and writing (14 percent) or math (15 percent). About three in 10 parents (28 percent) give a low grade (C, D or F) to their child’s school on providing enough time for physical education, while almost seven in 10 parents (68 percent) report that their child’s school does not provide daily physical education classes, a recommendation included in U.S. Centers for Disease Control and Prevention guidelines for schools. “In a period with a significant public debate about the content of educational reform, it is significant that many parents feel that more physical education is needed in the schools,” said Robert Blendon, ScD, Richard L. Menschel professor of Health Policy and Political Analysis at Harvard. Read more on education.
The Alliance for Health Reform will hold a briefing today in Washington, D.C. on an increasing trend at hospitals of "observing"—instead of admitting—Medicare beneficiaries to hospitals. The briefing follows an AARP report issued earlier this month, Rapid Growth in Medicare Hospital Observation Services: What’s Going On?. The report found that a key reason for the rise in hospital observations among Medicare beneficiaries is that under the Affordable Care Act hospitals can face penalties of 2 percent of hospital charges for patients readmitted to the hospital before thirty days after discharge—which don’t apply if the patient is observed rather than admitted.
Observation status is a long-standing one. For decades it has allowed emergency room staff to determine whether it’s safe for the patient to be sent home. But patients may face higher charges in the emergency room than they would as an inpatient, and may not qualify for Medicare-covered nursing home care after their hospital stay if they were observed and not admitted.
The AARP report analyzed the frequency and duration of the use of observation status for Medicare beneficiaries between 2001 and 2009. It found more than 100 percent growth over nine years, and an even greater percentage increase in the length of time spent in observation, with visits longer than 48 hours increasing the most.
“The dramatic increase in the use of observation status for Medicare patients deserves a closer look,” said Debra Whitman, AARP Executive Vice President for Policy, Strategy and International Affairs. “The clinical benefit of long-term observation remains questionable. And for Medicare patients who remain in the hospital under observation, they may not realize the high out-of-pocket costs they'll have to pay.”
Bipartisan legislation has been introduced in both the House and Senate to count the time spent in observation toward the three-day stay requirement.
>>Bonus Link: The focus of this month’s issue of Health Affairs is the future of emergency medicine.
>>Bonus Content: Follow the briefing on Twitter: #ObservationStatus
CDC: Measles Remains a Threat to U.S. Health Security
Fifty years after the creation of the measles vaccine, the disease continues to be a very real public health threat both in the United States and globally, according to the U.S. Centers for Disease Control and Prevention (CDC). While a recent study in JAMA Pediatrics confirmed U.S. measles elimination starting in 2000 and sustained through 2011, international travel means people from countries where the disease persists could still bring it to the United States. Approximately 158,000 globally died from measles in 2011, with an average of 430 children dying each day. These facts illustrate the need to be vigilant in reporting suspected cases to public health departments. “The steady arrival of measles in the United States is a constant reminder that deadly diseases are testing our health security every day,” said CDC Director Tom Frieden, MD, MPH. “Someday, it won’t be only measles at the international arrival gate; so, detecting diseases before they arrive is a wise investment in U.S. health security.” Read more on infectious disease.
HHS: $55.5M to Strengthen Training of U.S. Health Professionals, Especially in Nursing
The U.S. Department of Health and Human Services has announced the planned investment of millions to strengthen training for health professionals and add more professionals to the U.S. health care workforce, with a clear emphasis on nursing workforce development. About $45.4 million of the $55.5 million in FY 2013 will go toward nursing, including adding to the number of nurse faculty ($22.1 million), improving nurse diversity ($5.2 million), promoting interprofessional collaborative practice ($6.7 million) and supporting nursing education ($9.2 million). The more than 270 grants will also deal with overall public health, behavioral health and dentistry. Read more on nursing.
Switching to a Healthy Diet Adds About $1.50 Daily to Food Costs
Switching to a healthier may lighten your wallet a bit, but not so much that it isn’t worth it, according to a new study in the journal BMJ Open. Looking at 27 studies in 10 countries, researchers found that a diet that emphasizes fruits, vegetables, nuts and fish will add about $1.50 per day, or $550 per year, to an individual’s food budget. Healthy proteins such as boneless, skinless chicken breast were behind most of the additional costs. While this difference could be an issue for low-income families, middle-class families shouldn’t see much of a problem in making the healthy switch, according to study author Mayuree Rao, a junior research fellow in the department of epidemiology at the Harvard School of Public Health. "$1.50 is about the price of a cup of coffee and really just a drop in the bucket when you consider the billions of dollars spent every year on diet-related chronic diseases." Read more on nutrition.
Beginning later next year, more than a million workers in New York City will have a brand new, health-promoting benefit: paid sick leave days that guarantee wages on a set number of days when they or a family member they care for is ill.
The new law, passed last June by the New York City Council and overriding an earlier veto by the mayor, begins to go into effect in April 2014. New York now joins San Francisco, Calif., Washington, D.C., Seattle, Wash., Portland, Ore., and the state of Connecticut in adopting at least some sick leave provisions.
Not every employee in New York City will get paid sick leave under the new law. The bill that passed the City Council initially applies only to businesses with 20 or more employees, who will be required to provide five paid sick days a year; that extends to companies with 15 or more employees beginning October 1, 2015. Smaller businesses and manufacturing firms are exempt from the paid leave provisions for now, though these workers will gain five days of unpaid sick leave, so they can take time off without fear of losing their jobs. Advocates hope to extend paid leave to cover those workers before long.
Advocates say paid sick leave is critical for smaller businesses, and especially for low wage earners. A survey by the Community Service Society (CSS) of New York found that half of low-income respondents said they have less than $500 to fall back on in case of an emergency, and according to CSS, without compensation for sick days, people are often forced to choose between caring for themselves or a loved one and heading to work.
A 2012 study in the American Journal of Public Health shows why the measure that is critical to individuals and families is equally crucial to society as a whole. The study found that lack of certain workplace policies, including paid sick leave, led to an additional 5 million cases of adult H1N1 (swine flu) during the 2009 outbreak.
Funding for much of CSS’s advocacy came through a County Health Rankings & Roadmaps grant to focus on four areas in two New York City boroughs, the Bronx and Brooklyn, that have very poor health rankings. The goal was to build support among small businesses, faith-based organizations and low-wage workers for passage of the ordinance through grassroots events, town halls, story collection and media coverage, as well as by encouraging partners and allies to include this policy as part of their policy agendas. The grant runs through November 2014 and CSS will be focusing its efforts, now that legislation has passed, on creating awareness and implementation of the new law.
NewPublicHealth recently spoke with Nancy Rankin, vice president for policy, research and advocacy at CSS about the new law and its impact.
NewPublicHealth: Key components of the legislation you advocated for passed. What’s next in your efforts on paid sick leave?
Nancy Rankin: We are continuing to work on this issue because we recognize that having a law pass is not the end of the story. We now need to do outreach to inform workers about their new rights and employers about their new requirements, because a new law requires compliance and it requires people to be aware of its provisions.
HealthCare.gov: After Fixes, More Enroll in First Two Days of December than Did in All of October
The five weeks spent working on many of the problems of the HealthCare.gov website seem to have been time well spent, with more people signing up for the new health insurance in the first two days of December than were able to enroll in all of October. About 29,000 signed up for the insurance, made possible by the Affordable Care Act, on Sunday and Monday; only about 27,000 people signed up in October when the site first went live. While the final numbers have not been released, about 100,000 are estimated to have signed up via the site in November. The website is used in 36 states, with fourteen states and Washington, D.C. running their own sites. Read more on the Affordable Care Act.
Boston Adds Rentable Bicycle Helmets to Bikeshare System
Boston is working to improve the safety of people who use Hubway, the city’s popular bikeshare system, by installing the first vending machine for renting bicycle helmets. The HelmetHub street kiosk will be located at the Boylston Street and Massachusetts Avenue Hubway Station. Riders will be able to rent a helmet for 24 hours for $2, or purchase one to keep for $20; they will be sanitized and inspected after each use. The city intends for this test kiosk to be the first of many throughout Boston. Read more on safety.
Study: Social Ties, More than Biology, Responsible for Changes in Teen Sleep Times
Social ties—especially with parents and friends—may be more responsible than biology for whether a teenager gets enough sleep. While past studies have linked biological development factors to why children tend to sleep less as they age into teenagers, a new study in the Journal of Health and Social Behavior ties the trend more closely to the quality of the teen’s social ties. In an analysis of data on almost 1,000 kids ages 12 to 15—during with the average sleep time drops from 9 hours per school night to 8 hours—researchers concluded that teens who felt that they were a part of school, who were close to their friends and especially who had parents who were active in their life were more likely to get more sleep. "Research shows that parents who keep tabs on their kids are less likely to see them get into trouble or use drugs and alcohol," said David Maume, a sociology professor at the University of Cincinnati. "My findings suggest a similar dynamic with sleep. Parents who monitor their children's behavior are more likely to have kids that get adequate rest. Given that children generally get less sleep as they become teenagers, parents should be ever more vigilant at this stage.” Read more on pediatrics.
As colder weather begins to set in, a new story on the homeless from Atlantic Cities is particularly striking: According to the U.S. Department of Education, the number of homeless students in the United States has hit a record high number.
For the 2011 school year—the latest year for which the department has data—1,168,354 homeless children were enrolled in U.S. schools from nursery through 12th grade. Nationally, that is a 10 percent jump over the previous school year, and a whopping 72 percent increase since the recession began in 2008. More striking numbers: more than 40 states showed a rise in homelessness among kids and ten states saw the number of kids without a space to call their own rise more than 20 percent since 2008.
The lack of a safe home and limited access to health care leaves America’s homeless at especially high risk for a large number of health problems. According to a fact sheet from the National Health Care for the Homeless Council, “Without homes, people are exposed to the elements, disease, violence, unsanitary conditions, malnutrition, stress and addictive substances. Consequently, their rates of serious illnesses and injuries are three to six times the rates of other people. These conditions are frequently co-occurring, with a complex mix of severe physical, psychiatric, substance use and social problems.”
>>Bonus link: Continue reading even after the numbers jump out at you to learn about a ten year old girl, reported by the San Jose Mercury News, who rides a bus with her father in Santa Clara County, Calif., each night since the $70 monthly pass makes it an affordable option. The fact that the young girl is having “one of her best years so far in school,” according to her father, is all the more remarkable considering they have to get off and reboard that bus about every two hours.
NHTSA: Motorcoaches, Large Buses to Require Seatbelts for All Passengers and Driver
New motorcoaches and large buses will be required to provide lap and shoulder seatbelts for all passengers and driver, under a new rule issued by the U.S. Department of Transportation's National Highway Traffic Safety Administration (NHTSA). While the buses are an overall safe way to travel, the large numbers of people they carry and the high speeds at which they travel mean a single collision can lead to a significant number of injuries, according to NHTSA. An average of 7,934 riders are injured each year in motorcoaches, and an average of 21 passengers are killed. "Buckling up is the most effective way to prevent deaths and injuries in all vehicular crashes, including motorcoaches," said Federal Motor Carrier Safety Administrator Anne S. Ferro, in a release. "Requiring seat belts in new models is another strong step we are taking to reach an even higher level of safety for bus passengers." The rule will apply to buses with a gross vehicle weight rating (GVWR) greater than 26,000 pounds,) excluding transit buses and school buses. Read more on transportation.
Study: Women With Breast Cancer Should Get Mammograms Every 12 to 18 Months
Breast cancer patients should undergo mammograms every 12 to 18 months to determine whether their cancer has spread to the lymph nodes, according to a new study to be presented today at the annual meeting of the Radiological Society of North America. Study researcher Lilian Wang, MD, evaluated more than 300 women who were diagnosed with breast cancer because of a routine mammogram, dividing them into three groups based on their treatment history. She found that only 9 percent of the women who had 12- to 18-month intervals between mammograms saw their cancer spread to their lymph nodes; the rates were 21 percent for those who waited one-and-a-half to three years and 15 percent for those who waited three or more years. "If you catch someone with early stage cancer, they are going to need less extensive surgery, and maybe no chemo," said Laura Kruper, MD, director of the Cooper-Finkel Women's Health Center at the City of Hope Cancer Center, in Duarte, Calif., who was not a part of the study. "[The new study] adds more power behind the fact that we do need screening mammograms starting at age 40 and every year.” Read more on cancer.
FDA: Certain HeartStart AEDs May Not Work During Cardiac Emergencies
The U.S. Food and Drug Administration (FDA) announced yesterday that certain automated external defibrillator (AED) devices made by Philips Medical Systems may not function properly when needed. In a new safety communication, FDA revealed that the devices may not deliver the needed shock to restore normal heart rhythm during a cardiac emergency. “The FDA advises keeping all recalled HeartStart AEDs in service until you obtain a replacement from Philips Healthcare or another AED manufacturer, even if the device indicates it has detected an error during a self-test,” said Steve Silverman, director of the Office of Compliance in the FDA’s Center for Devices and Radiological Health. “Despite current manufacturing and performance problems, the FDA considers the benefits of attempting to use an AED in a cardiac arrest emergency greater than the risk of not attempting to use the defibrillator.” Read more on heart health.
Several weeks ago, the Harvard School of Public Health celebrated its Centennial with fanfare, fundraising and a panel discussion featuring world health leaders who are graduates of the school. Following the centennial, NewPublicHealth spoke with the School’s Dean, Julio Frenk, MD, MPH, PHD, who has a joint appointment at the Harvard Kennedy School of Government. He is also a former health minister of Mexico and a former senior fellow in the global health program of the Bill and Melinda Gates Foundation.
NewPublicHealth: What do you think have been the key changes in public health efforts since the Harvard School of Public Health was founded 100 years ago?
Julio Frenk: The 100 years that have passed since the School of Public Health was founded are not just any 100 years—they’re the 100 years with the most intense transformations in health in human history. We have seen a more than doubling of life expectancy since the school was founded. Around 1900, the global average for life expectancy was 30 years. At the end of the century, the global average was about 65 years. It more than doubled in the 20th century, and that increase has continued with some setbacks, most notably the AIDS epidemic in Saharan Africa. And we have had a qualitative shift not just in the level of mortality, but in the causes of death. So we went from a preponderance of acute infections to now a predominance of mostly chronic non-communicable diseases, and that’s an incredible transition.
A critical change is that the experience of illness became very different starting from the beginning of the 20th century. Before then, illness was mostly a succession of acute episodes, from which one either recovered or died. If you recovered, you went on to get your next acute illness. Now, illness is more a condition of living. People live with cancer. People live with AIDS. So that’s a big transformation of the patterns of health, disease and death.
Another big change is the emergence of complex health systems, and that’s—again—a process that started at the beginning of the 20th century. Before the 20th century, the social function of the sick was mostly trusted to undifferentiated institutions, such as the family or religious institutions, and it’s not until the 20th century when you see this incredible explosion of specialized institutions and specialized human resources, doctors, nurses and other health professionals. In the 20th century, healthcare is 10 percent of the global economy and employs millions of people, including eight million doctors. These are all profound transformations.
NPH: How has the training of students of public health changed in the last 100 years?
Frenk: There has been profound change. What happened at the beginning of the 20th century was the emergence of public health as a field of action. The practices of engineering emerged in Europe, especially with the rapid urbanization there starting around the 17th century, but then greatly expanded in the 18th century. Engineering allowed for access to clean water and taking care of waste, which resulted in some diseases coming under control. In the 19th century the discovery of microbiology gave rise to the abolishment of the germs as causes of illness. That is the junction that gives birth to public health, along with the idea of social policy, of social activism that actually changed social conditions. It’s in that mix that public health gets shaped.